When treating adolescent patients who are making the important, sometimes bumpy crossing from a pediatric to an adult rheumatology practice, there’s no one-size-fits-all approach. “We have to be flexible on the receiving end when talking with these patients, and flexible with their families, too,” says Peter A. Nigrovic, MD, director of the Center for Adults…
Take the challenge. D—As of January 2015, there are three new codes added to the arthrocentesis codes of 20600–20611. The new codes, 20604, 20606 and 20611, should be reported when the procedure is performed with ultrasound guidance and CPT 76942 should not be billed separately. The three new codes are defined as: 20604—Arthrocentesis, aspiration and/or…
Our elected officials make decisions every day that affect our lives and the lives of our patients. These decisions are often based on input they have received from advocates and lobbyists, constituents and fellow lawmakers. Regardless of our ideals, money plays a role in this decision making, because political contributions facilitate access to legislators and…
A 38-year-old female patient returns to the practice for the second of three hyaluronate sodium injections of the left knee. The patient states the pain is somewhat better after her last injection. Her weight is 165 lbs., her height is 5 feet 6 inches, and her blood pressure is 120/81. After discussing the risks of…
Once the barriers to telemedicine are overcome, this modern approach to the practice of medicine solves patient access issues and increases physician productivity, says Daniel Albert, MD, a pediatric rheumatologist at the Center for Telehealth at Dartmouth-Hitchcock Medical Center…
The decision to continue or discontinue immunomodulatory medications during pregnancy is a difficult one for both patients and physicians. On the one hand, when left untreated, rheumatic conditions can cause harm to an unborn child, as well as to the pregnant mother. On the other hand, medications can be harmful to a developing fetus. In…
A large medical specialty society for ophthalmologists recently updated its recommendations for the screening of chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy.1 The recommendations from the American Academy of Ophthalmology (AAO) affect patients who may use CQ or HCQ for rheumatoid arthritis or systemic lupus erythematosus (SLE), as well as some inflammatory and dermatologic conditions. The…
Depending on stage, severity and rate of progression of disease, systemic corticosteroids are commonly used to treat pulmonary sarcoidosis. However, a review of the literature suggests they have limited usefulness in advanced stage IV pulmonary sarcoidosis. Once sarcoidosis has advanced to this degree, steroid use may unnecessarily expose a patient to life-threatening complications, as demonstrated…
Both due to its efficacy and favorable side effect profile when compared with alternative drugs for rheumatologic conditions, hydroxychloroquine is an important agent in rheumatologists’ armamentarium. However, one barrier to hydroxychloroquine use can be its effects on the eye (also see “Revised Retinopathy Screening Guidelines,”). Ocular side effects of hydroxychloroquine can include impact on the…
A 73-year-old white male presented with a one-day history of a cold, painful, right foot. The foot had a blue discoloration to it, particularly the toes. The emergency physician suspected an atheroembolic cause, given this patient’s age and history of coronary artery disease. However, the patient also reported a one-year history of painful pallor in…